Effects of rapid maxillary expansion on temporomandibular joints

Condylar volume comparison after rapid maxillary expansion by Haas and Hyrax in growing patients: A retrospective cross-sectional study

PURPOSE

This study aimed to evaluate the condylar volume of growing patients after rapid maxillary expansion (RME) by Haas and Hyrax appliances.

METHODS

This retrospective cross- sectional study assessed the records of patients diagnosed with transversal maxillary deficiency and with incomplete maturation of midpalatal suture. RME was performed with Haas or Hyrax appliances. Condylar volume was obtained by segmentation of DICOM images from cone-beam computerized tomographys before (T1) and after one year (T2) of RME. The results were compared between the experimental times, sex, and appliances by parametric tests (alpha=5%).

RESULTS

Twenty-seven patients were included (128±21 months old). There were no statistical differences in condylar volume between experimental times (T1 and T2), sex, and appliances to the right and left condyle (P>0.05).

CONCLUSION

RME by Haas or Hyrax does not impact the condylar volume of growing patients.

Condylar changes in adult patients with unilateral posterior crossbite following microimplant-assisted rapid palatal expansion: A retrospective CBCT study

OBJECTIVES

This study aimed to assess the alterations in condylar positioning in adult skeletal Class I patients with unilateral posterior crossbite following microimplant-assisted rapid palatal expansion (MARPE) treatment.

METHODS

This retrospective study involving 30 participants (10 males, 20 females) with an average age 22.9 ± 4.2 years, ranged from 18.1 to 30.9 years, who were treated with a customized microimplant-supported rapid palatal expander. Pre-expansion and post- comprehensive orthodontic treatment CBCT images (20-26 ±2.1months) were analyzed to assess the condylar changes before and after treatment. We measured the temporomandibular joint (TMJ) in the three dimension in terms of: (1) The position and angle of the mandibular condyles; (2) How centralized the condyles were in their particular mandibular fossae; and (3) The volume of the TMJ and the joint spaces. To evaluate the differences between the T1 and T2 samples, we used the paired t-test and the Wilcoxon signed rank test.

RESULTS

Before treatment, minor differences were noted in the anterior joint space (AJS), superior joint space (SJS), and anteroposterior condylar joint position (APCJP) between the crossbite and non-crossbite sides, though these differences were not statistically significant. Post-treatment, the condyles on both sides assumed a more posterior position, yet significant asymmetry in the AJS persisted (P < .05). The crossbite-side condyle also showed a tendency to rotate toward the non-crossbite side in the anteroposterior direction. While MARPE affected specific aspects of condylar positioning, achieving complete alignment remained challenging.

CONCLUSION

This study provides insightful observations on the enduring impacts of MARPE on TMJ spaces and position in adult patients suffering from a unilateral posterior crossbite.

Investigation of changes caused by Rapid Maxillary Expansion in mandibular bone and temporomandibular joint trabecular structure using fractal analysis

BACKGROUND

The aim of this study is to evaluate the changes in the trabecular structure of the mandibular bone and temporomandibular joint following Rapid Maxillary Expansion.

METHODS

Thirty-nine patients who received Rapid Maxillary Expansion treatment in the Department of Orthodontics of the Faculty of Dentistry were selected from the archieve for the study. Trabecular structure changes of the angulus mandible, corpus mandible, and condyle regions were examined using fractal analysis on the dental panoramic radiographs. Radiographs taken before the treatment (T0) and at the end of the 3-month retention period (T1) of the patients.

RESULTS

There was no statistically significant difference between T0 and T1 in the condyle, ramus mandible, and corpus mandible regions depending on time and sex. (p < 0.05) CONCLUSION: The results of this study showed that Rapid Maxillary Expansion treatment does not have a significant impact on the trabecular structure of the mandible and temporomandibular joint depending on time and gender.

Evaluation of condylar dimension and position following rapid maxillary expansion with tooth- or tooth-bone-borne appliances

Objective

To assess and compare changes in the dimension and position of the mandibular condyle after tooth-borne (Hyrax) and tooth-bone-borne (Hybrid Hyrax) expansion.

Methods

Twenty-five patients who underwent expansion with either tooth-borne appliances (8 girls, 5 boys; mean age 14.3 ± 2.3 years) or tooth-bone-borne appliances (6 girls, 6 boys; mean age 13.8 ± 2.2 years) were examined. Condylar and glenoid fossa morphology before (T0) and 3 months after (T1) expansion were evaluated using cone-beam computed tomography. Condylar measurements (anterior, posterior, and superior joint spaces; condylar height, length, and width), along with sagittal and vertical skeletal and maxillary transversal measurements, were analyzed using Dolphin Imaging software. Wilcoxon and Paired t tests were used for T0 and T1 evaluations, and the Mann-Whitney U test for intergroup comparisons.

Results

At both T0 and T1, no statistically significant differences were observed between the groups in terms of condylar dimensions or the position of the condyle within the glenoid fossa. Maxillary transversal measurements increased after expansion in both groups (P < 0.01), with a significantly greater increase in first premolar width in the Hyrax group (P < 0.05). The vertical position of the posterior teeth showed no noteworthy changes (P > 0.05), except for the right second premolar. Temporomandibular joint measurements did not significantly change in either group after treatment (P > 0.05).

Conclusions

Neither tooth-borne nor tooth-bone-borne expansion caused significant changes in the condylar dimensions and position at the end of treatment.

Analysis of changes and correlation in condyle-fossa relationship after maxillary skeletal expansion

OBJECTIVE

To investigate the changes in condyle-glenoid fossa relationship after maxillary skeletal expansion (MSE) and to verify the correlation between the condyle positional changes and expansion effect.

METHODS

In this study, 20 patients (mean age 21.1 ± 5.7 years, 8 male, 12 female) with maxillary transverse deficiency (MTD) were treated with the MSE appliance, which contained molar bands and a expander with four micro-implants. The CBCT images were taken before expansion (T0), after expansion (T1) and after 6 months of maintenance (T2). The posterior TMJ space (PS), superior TMJ space (SS), anterior TMJ space, coronal lateral TMJ space (CLS), coronal medial TMJ space (CMS), condyle axis angle, maxillary basal bone width (BWM), inter-molars width, nasal bone width, molar inclination and molar palatal cusp height (U6H) were measured using Dolphin Imaging.

RESULTS

At T1, compared with T0, the PS and SS significantly increased by 0.41 mm (P = .008) and 0.3 mm (P = .007). But only the SS significantly increased by 0.21 mm (P = .025) at T2. There was a significant difference of 0.37 mm (left-right, P = .014) between the left and right SS at T0, but no significant difference at T1 and T2. The increased BMW showed weak positive correlations with the change of PS (P = .015) and CMS (P = .031), and the decreased U6H showed weak negative correlations with the change of PS (P = .015) and CLS (P = .031) at T1.

CONCLUSIONS

The use of MSE led to an increase in the SS and PS, which were weakly correlated with BWM and U6H. But this effect in the TMJ space gradually diminished after 6 months of maintenance, and the symmetry of the condyle-fossa relationship was preserved.

Effect of Molar Distalization on Condyle-Glenoid Fossa Relationship

Objective

It is essential to be aware of the potential effects of orthodontic treatment on tissues and anatomical structures associated with the masticatory system, especially the temporomandibular joint (TMJ). Little information is available about the consequences of molar distalization on the TMJ. Therefore, this study is aimed at investigating the changes of the condyle-fossa relationship after molar distalization using the distal jet appliance.

Materials and Methods

The sample consisted of twenty-five patients (mean age 20.4 ± 2.6) who underwent molar distalization by the distal jet appliance. CBCT scans were taken before (T0) and after (T1) the completion of the molar distalization. Joint spaces (anterior, superior, and posterior) and cephalometric vertical angles (SN.GOME and Björk sum) were measured and compared at T0 and T1.

Results

Superior and posterior joint spaces increased significantly after molar distalization (PS 0.29 mm, P < 0.001, SS 0.06 mm, P < 0.5). Vertical cephalometric angles also increased after molar distalization by the distal jet appliance (SN.GOME 0.92°, Björk 1.11°).

Conclusion

There was a statistically significant increase in the superior and posterior joint spaces after molar distalization. However, this increase may not be of clinical importance. The vertical dimension has also increased.

The Impact of Childhood Attention-Deficit/Hyperactivity Disorder (ADHD) on Children's Health-Related Quality of Life: A Systematic Review and Meta-Analysis

OBJECTIVE

To investigate the association between children's health-related quality of life (HRQoL) and childhood attention-deficit/hyperactivity disorder (ADHD).

METHOD

Databases were systematically searched for peer-reviewed literature published between 2010 and 2022. Two reviewers independently screened and assessed the quality of included studies. Meta-analysis was conducted for studies that used the Pediatric Quality of Life Inventory (PedsQL).

RESULTS

Twenty-three studies were included, with most rated as "good" quality. Meta-analysis found "very large" effect in both parent- (Hedges' g -1.67, 95% CI [-2.57, -0.78]) and child-reported (Hedges' g -1.28, 95% CI [-2.01, -0.56]) HRQoL for children with ADHD compared to children without ADHD. No difference between parent- and child-reported HRQoL in children with and without ADHD was found. However, parent-reported HRQoL was lower than child-reported HRQoL among children with ADHD.

CONCLUSION

ADHD was associated with substantially poorer children's HRQoL. Among children with ADHD, parents rated their children's HRQoL lower than the children themselves.

Condylar morphology and position changes after miniscrew-assisted rapid palatal expansion in skeletal Class III malocclusion adult patients with mandibular deviation and unilateral posterior crossbite

BACKGROUND

To evaluate the morphological and positional changes of mandibular condyle after miniscrew-assisted rapid palatal expansion (MARPE) in skeletal Class III malocclusion adult patients with horizontal mandibular deviation (MD).

METHODS

The sample consisted of 15 patients with MD (6 males and 9 females, mean age 21.58 ± 3.12 years). The CBCT scans were taken before and after MARPE immediately. The pre- and post-registered images of the cranial base and mandible were measured, respectively, by Mimics.

RESULTS

After expansion, the distance between superior condylar point and the Frankfort horizontal plane on the deviated side and the non-deviated side increased by 0.96 ± 0.60 mm (P = 0.011) and 0.70 ± 0.65 mm (P = 0.046); coronal condylar angle of the deviated side increased by 0.39° ± 0.34 (P = 0.028) and 0.06° ± 0.49 (P = 0.917) on the non-deviated side. No statistically significant differences were found when comparing the condylar position on both sides before and after treatment. The degree of mandibular deviation decreased 0.43 mm (P = 0.270).

CONCLUSIONS

This study suggested that for skeletal Class III malocclusion adult patients with horizontal MD, the condyle on the deviated side rotated toward the non-deviated side in the coronal direction; the condylar remodeling occurred mainly on the deviated side after MARPE in the vertical direction.

Perceived Pain during Rapid Maxillary Expansion (RME): Trends, Anatomical Distinctions, and Age and Gender Correlations

Objectives

To investigate pain trends and characteristics of different facial districts in patients undergoing rapid maxillary expansion (RME) and its possible correlations with age and gender.

Materials and Methods

85 subjects (45 males and 40 females) undergoing RME were selected and analyzed during first two weeks of treatment. Patients rated daily two types of pain perception: the general perceived pain (GPP), i.e., the pain overall perceived in the face, and the local perceived pain (LPP), i.e., the pain perceived locally in the following anatomical areas: anterior palate (APA), posterior palate (PPA), nasal (NA), joint (JA), and zygomatic (ZA). Patients were provided the Numeric Rating Scale (NRS) and Wong–Baker Faces Pain Rating Scale (FPS) to correctly assess their GPP and LPP. Pearson correlation coefficient and analysis of variance (ANOVA) were, respectively, used to define the linear relationship between all the variables considered and to verify whether the response variables (gender and age) were significantly different (α < 0.05).

Results

Sample's mean age was 10.11 years. Average pain values of GPP and LPP progressively rise from day 1 to days 2-3 (pain peak) and tended to decrease until day 14, with a linear decrease for GPP and a not linear decrease for LPP. PPA and APA resulted the most painful areas, followed, respectively, by JA, ZA, and NA. Statistically significant differences resulted in average pain values according to patients' age and gender, both in GPP and LPP.

Conclusion

RME causes perception of pain in several maxillofacial areas. Pain reported during RME resulted positively correlated with age and gender of patients.

Bone-anchored versus tooth-anchored expansion appliances: Long-term effects on the condyle-fossa relationship

BACKGROUND

The objective of this study was to evaluate the short-term and long-term effects of tooth-anchored and bone-anchored maxillary expansion appliances on the condyle-fossa relationship, compared to those in a matched control group. Another objective of the study was to evaluate whether the amount of dental and skeletal expansion is correlated with the condyle-fossa relationship.

METHODS

A total of 180 cone-beam computed tomography scans (CBCTs) for 60 subjects were analyzed for 3 groups: 1) bone-anchored maxillary expansion (BA; n = 20); 2) tooth-anchored maxillary expansion (TA; n = 21); and 3) controls (n = 19) at pretreatment, post-expansion (T2), and post-treatment (T3). The posterior joint space (PJS), superior joint space (SJS), anterior joint space, angle of mandibular condyle, distance of the condyle to the mid-sagittal plane, the inter-molar cuspal width, and the skeletal maxillary width (SMW) were measured for all 3 groups.

RESULTS

Both BA and TA led to a significant increase in inter-molar cuspal width, SMW, and TA led to a significant increase in PJS as compared to controls at T2. However, there was no significant difference in the joint spaces between the BA, TA, and control groups in the long term. Both the BA and TA groups showed a significant increase in SMW at T3 compared to the control group. Molar extrusion showed a weak correlation with PJS at T2 (r = 0.46) and T3 (r = 0.51), and a moderate correlation with SJS at T2 (r = 0.61) and T3 (r = 0.69).

CONCLUSIONS

TA led to a significant increase in PJS, compared to a control group, at T3, but there was no long-term difference in the condyle-fossa relationship among the BA, TA, and control groups. Molar extrusion showed moderate correlation with SJS and PJS.

Rapid Maxillary Expansion May Improve Condyle-Fossa Relationship and Intercondylar Symmetry

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

Effects of rapid maxillary expansion on temporomandibular joints: A systematic review. Torres D, Lopes J, Magno MB, Cople Maia L, Normando D, Leão PB. Angle Orthod. 2020 Feb 10. https://doi.org/10.2319/080619-517.1. Epub ahead of print. PMID: 32039632.

SOURCE OF FUNDING

None. The authors have no actual or potential conflicts of interest.

TYPE OF STUDY/DESIGN

Systematic review.

Cone beam computed tomographic evaluation of the changes in condylar position in growing patients with unilateral posterior crossbite undergoing rapid maxillary expansion followed by fixed orthodontic therapy

PURPOSE

This study aimed at assessing changes in condylar position (CP) in growing patients with unilateral posterior crossbite (UPC) undergoing rapid maxillary expansion (RME) followed by fixed orthodontic treatment (FOT) (experimental-group); and growing patients without posterior crossbite (PC) treated with FOT alone (control-group).

METHODS

Cone beam computed tomography (CBCT) images were obtained before treatment (T0), 6 months after RME (T1) and after FOT (T2) for the experimental-group (n = 19); and at T0 and T2 for the control-group (n = 22). Condylar position-related measurements including the anterior joint space (AJS), superior joint space (SJS), posterior joint space (PJS), lateral position of condyle (LC) and condylar angle (CA) were measured. Non-parametric tests were used.

RESULTS

On the crossbite side, significant increases were found in LC (P = 0.039) and CA (P = 0.007), and on the non-crossbite side significant increases were observed in SJS (P = 0.027) and LC (P = 0.001) between T0, T1 and T2 in patients with UPC. On the right and left sides in the control-group, significant increases were identified in LC (P < 0.001 and P = 0.012, respectively) between T0 and T2.

CONCLUSIONS

In growing patients with UPC, RME followed by FOT is associated with significant changes in CP-related measurements.